Online Forms

Day Admission Consent Form

Thank you for choosing Creekside Veterinary Hospital! Please fill out this form as completely and accurately as possible before your scheduled appointment with us.

You are welcome to familiarize yourself with this form. A CVH employee will help you complete it at the time of intake.

Owner's Name *

First

Last

Best phone number for today's appointment: *

(The veterinarian and technician will use this number to communicate with you through the appointment.)

Text? *

Patient's Name *

Convenience day exam/annual stay & play *

Appointment Date/Time *

Date

Time

Purpose of Visit *

Hospitalization for > 24 hours
Glucose Curve
Diabetes Testing
Cushing’s Disease Testing
Addison’s Disease Testing
Ultrasound/Echo
Urine Collection
Convenience Day Exam

Other/additional needs:

Estimate of Fee Schedule for duration of visit:

In the case that different or additional diagnostic tests, treatments, or methods are needed during my pet’s visit today: *

I AUTHORIZE up to $150 in additional tests or treatments per Doctor’s discretion without a phone call
I AUTHORIZE sedation for treatment if necessary

The CVH team has assessed your pet’s stress level as and believe your pet would benefit from mild stress relief medicine while at the hospital today, which will be dosed and prescribed by the doctor. Do you consent to a mild stress relief pill being given to your pet if needed? *

As the owner of the above pet, I accept that there are inherent risks involved in the care I’ve requested. I hereby authorize the doctors and team at Creekside Veterinary Hospital to prescribe medications for, perform treatments on, pursue life-saving emergency procedures for, and as agreed upon, sedate or anesthetize and perform surgery or other procedures on my pet *

I have read, understand, and authorize

I agree to pay all fees associated with these treatments according to the policies set forth by the practice and I understand that full payment for services and products is expected at the time my pet is ready to be discharged from this facility. *

I have read, understand, and agree

I or an authorized agent will be present to pick up the aforementioned patient at the date below or sooner if the team explicitly notifies me that the patient is ready earlier. If I cannot or do not fulfill the agreements set forth in this consent form, I accept that ownership of my pet can be transferred to Creekside Veterinary Hospital per Tennessee State Law Code #62-12-134. *

I have read, understand, and agree

Advanced minimum deposit of half your estimate is required for animals left for hospitalization of greater than 24 hours unless prior arrangements have been made. *

I have read, understand, and agree

Pick up time:

Signature of Owner or Agent *

Date *

Comment

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we know that pets are family.

We believe you deserve compassion, integrity, and collaboration with each step of your pet’s life. Come meet us! We can’t wait to help you and your pet.

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

Address

2987 Hunting Dr. NW, Cleveland, TN 37312



Contact

E: [email protected]
P: 423-709-7979
T: 423-799-2937

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Hours

Mon: 8 am – 6 pm
Tue: 8 am – 6 pm
Wed: 8 am – 1 pm
Thu: 8 am – 6 pm
Fri: 8 am- 6 pm

** Our hours are set to expand! As soon as we can grow to add more employees and doctors, we will be offering even more hours for your convenience and for your pet’s urgent needs! **

Name *

First

Last

Email *

Phone

How can we help you? *

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Our appointment booking system is coming soon!